Republic of the Philippines)

La Trinidad, Benguet) s.s

x- - - - - - - - - - - - - - - - -x

AFFIDAVIT OF LOSS

I, Clifford B. Agdasi, of legal age, single, Filipino, and a resident of FD 177, Pines Park,
Balili, La Trinidad, Benguet after having been duly sworn to in accordance with law, do hereby
depose and state THAT:

1. I am a bonafide holder of a Training Certificate on Medical Emergency First Aid

issued by Nippon Yusen Kaisha-Transnational Diversified Group Training Center
(NYK-TDG Training Center), of Canlubang, Calamba, Laguna. The said certificate
was issued to me sometime in 2013;

2. After I secured a copy of the same, I kept it in my possession. Recently, I applied for
a Certificate of Proficiency with the Maritime Industry Authority (MARINA) and the
said training certificate was required. I therefore submitted the same as one of the
requirements. Thereafter, my Certificate of Proficiency was issued and the afore-
mentioned Training Certificate on Medical Emergency First Aid was returned to me.
When I was supposed to submit the same to the office of NYK-TDG Training Center
for file or records purposes lately, I noticed the same to be missing and can no longer
be found on the files where I last kept it. I immediately and diligently locate or search
the same where it may have been placed. Unfortunately, I was not able to locate or
found the same.

3. Despite my earnest efforts to locate or find my Training Certificate on Medical

Emergency First Aid, the efforts prove futile. I therefore considered it loss and
beyond recovery;

4. I hereby attest that the said training certificate was not used for any illegal or
unlawful purposes;

5. I am executing this Affidavit to request NYK-TDG Training Center to issue a new

Training Certificate on Medical Emergency First Aid in lieu of the lost one. That, I
hereby bind myself to fully excuse NYK-TDG Training Center for any damage or
liability that it may incur for the issuance of the requested certificate;

6. Finally, I am executing this affidavit to attest to the truthfulness of the foregoing facts
and for all legal intents and purposes it may serve well.

IN WITNESS WHEREOF, I have hereunto set my hand this 3rd day of October 2017
at La Trinidad, Benguet, Philippines.

Clifford B. Agdasi
Affiant
TIN 407-795-598-000

SUBSCRIBED AND SWORN to before me a Notary Public for and in La Trinidad,

Benguet, Philippines this 3rd day of October 2017 by the above Affiant personally known to me
of his identity and identified by to be the same person who personally signed before me the
foregoing Affidavit.

ATTY. CYRUS C. CALAYA

Doc. No. 387; Notary Public until Dec. 31, 2017
Page No. 78; PTR No. BGT 5080030; February 15, 2017
Book No. II; IBP Lifetime No. 08051, at Pasig City
Series of 2017. Roll No. 52590, May 12, 2006; Manila
S & B Bldg., FA 224, Km. 4
National, Highway La Trinidad, Benguet